| NPI | 1003140260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50-001369) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.001369) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2010-09-03 |